Jim Kim: AIDS response set path for universal health care

When Dr. Jim Kim, President of the World Bank, began advocating for universal access to HIV treatment for the world’s poorest and most vulnerable in 2000, he met a strange response, that he recounted this week.

“People were angry that we were talking about treating people with HIV/AIDS,” he said. “It’s as if people were saying that if it were possible to do, we would have done it already.”

He hears the same criticisms about his more recent cause: universal health coverage for all.

The successes and lessons from the global AIDS movement, he said, at a Center for Strategic and International Studies event launching a report on global action toward universal health coverage, can be used to realize the ambition of affordable and equitable health care for the world’s poorest.

With 150 million people forced into catastrophic poverty each year by health care costs, the establishment of universal health coverage, is economically as well as morally essential, Kim said. “Global health investments are imperative for poverty reduction,” he said. “Better investments in health can result in a 9-to-24 time return in full income.”

The World Bank is working with the World Health Organization to develop a framework for universal health care, he said. Their aim is to reduce by half the number of people who become impoverished due to out-of-pocket health care expenses by 2020, and by 2030 to ensure that no one falls into poverty due to health costs. Also by 2030, they aim to double, from 40 to 80 percent, the proportion of poor in developing countries who have access to basic health services, including services for diabetes, hypertension, and other conditions.

Acknowledging that these goals aim high, Kim said that without ambitious targets set by PEPFAR, “I don’t believe today we’d have ten million people on ARVs.” He said that years ago he would never have believed that there would be billions of dollars devoted to HIV/AIDS. “I think this is one of the most extraordinary accomplishments in recent human history, and perhaps in all of global health.”

“It was HIV activists who got us from nowhere to now,” he said. Although “important leaders angrily defied our approach to more ART,” millions were treated and saved thanks to that activism. He said the world needs the same activism for universal health care to bolster political will. “We saw with AIDS that concrete action is possible with leadership,” he said. He also cited the Directly Observed Therapy system for tuberculosis control as another example that can be emulated to establish universal health care, saying the “DOTS strategy started from political commitment.”

It’s also very important to address market mechanisms to get much-needed new drugs to the people who need them the most, Kim said, citing the need for new drugs for multi-drug resistant tuberculosis and malaria. He added that drug development for HIV/AIDS has been comparatively better than for other diseases, “perhaps because there are 2.5 million people living with HIV in developed countries.”

Developing countries are already taking action to achieve universal health care, said Gina Lagomarsino, managing director at Results for Development Institute. Countries that include Vietnam, Ghana, Kenya, Indonesia, and India are creating new models of health care to suit their needs instead of mimicking developed country’s health care systems.

They’re all prioritizing government financing of services, and are increasing revenue and combining multiple sources of revenue to do so. For example, Ghana has created a value-added tax earmarked for their national health care system.

Countries are also attempting to create broad national coverage programs which bring together different seams of health care, such as health care for civil servants, the private sector, and the informal sector. Indonesia is currently merging five health care sectors to form the largest single-payer system in the world, which they hope will improve quality and increase efficiency.

“These efforts have already reduced out-of-pocket expenses, so less people are going into poverty,” she said.

Tim Evans, director of the health nutrition and population, human development network of the World Bank, said in a post Millennium Development Goal world after 2015, the World Bank will invest in increasing access to health care as a means of eliminating poverty. “The bottom 40 percent of the population need at least 80 percent coverage for essential services,” he said. “We move forward no matter what the post-2015 agenda is.”